364808413-8-4-2023-12-CC-KZIS-CUDTV7-20230804150328

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 364808413
Report Date: 08/04/2023
Date Signed: 08/04/2023 03:03:34 PM

Document Has Been Signed on 08/04/2023 03:03 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
PALMDALE CHILD CARE, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME:	SAN BERNARDINO CHILD DEVELOPMENT CENTER		FACILITY NUMBER:	364808413
ADMINISTRATOR:	LATASHIA KELLY		FACILITY TYPE:	830
ADDRESS:	2350 N. E STREET		TELEPHONE:	(909) 388-6307
CITY:	SAN BERNARDINO	STATE: CA	ZIP CODE:	92405
CAPACITY: 34	TOTAL ENROLLED CHILDREN: 20	CENSUS: 14	DATE:	08/04/2023
TYPE OF VISIT:	Case Management - Incident	UNANNOUNCED	TIME BEGAN:	01:40 PM
MET WITH:	Facility Representative, Annabell Lopez Magana		TIME COMPLETED:	03:15 PM

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On August 4, 2023, at 1:40 p.m., Licensing Program Analyst (LPA) Kendal Zirbes conducted an unannounced Case Management Incident inspection and met with facility representative, Annabell Lopez Magana. LPA disclosed the purpose of the inspection and was granted entry into the facility by the facility representative. 14 children and seven staff were present in the facility during the inspection.

The purpose of the inspection was to follow up on a self-reported unusual incident report (UIR) that occurred on June 28, 2023, at the facility. The Department was notified of the UIR on June 29, 2023. According to the UIR, child 1 (C1), child 2 (C2), and child 3 (C3) were observed in the parking structure which is outside of the enclosed play yard. According to the UIR, the maintenance workers left the gate unlocked after they had been working in the play yard before the toddlers went outside to play. Per UIR, C1, C2, C3 were immediately returned to the play yard and the gates were secured.

After receiving the UIR, the Department conducted an unannounced case management inspection on July 13, 2023, conducted confidential interviews with staff and parents and reviewed documentation. Interviews confirmed C1, C2 and C3 were observed in the parking lot outside the enclosed play yard. Per interviews, Staff 1 (S1), Staff 2 (S2), Staff 3 (S3) were in the enclosed play yard with nine children. While S1, S2, S3 were engaged in setting up a E-Z Up Pop-Up, C1, C2, C3 were playing with push toys around the play yard. C1, C2, C3 pushed the toys on the side of the building and were able to leave the enclosed play area through the side gate. Staff interviews confirmed they were unable to visually observe, C1, C2, and C3 on the side of the building while they were putting up the E-Z Up Pop-Up and did not observe the children leave the premises. Interviews confirmed, staff 4 (S4) a staff member who was inside the classroom was the first person to observe C1, C2, and C3 outside of the enclosed play yard. S4 was the first staff member to respond to the incident and bring C1, C2, and C3 back from the school parking lot into the play yard. Based on information obtained from interviews and measurements taken by LPA, C1, C2, and C3 were approximately 25 to 35 feet away from the side gate, in the center's parking lot, near the driveway. The parking lot/driveway leads to a busy main street where a bus stop is located. Report continued on page two

SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Kendal Zirbes
LICENSING EVALUATOR SIGNATURE:	DATE: 08/04/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/04/2023

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)

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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
PALMDALE CHILD CARE, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME: SAN BERNARDINO CHILD DEVELOPMENT CENTER	FACILITY NUMBER: 364808413
	VISIT DATE: 08/04/2023

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Report continued from page one

Based on interviews conducted with staff, the facility failed to ensure children were under direct visual observation and supervision by a staff person at all times, when C1, C2, and C3 wandered outside of the enclosed play area without S1, S2 or S3 observing. Therefore, California Code of Regulations, Title 22, Division 12, Chapter 1, regulation 101429 (a) (1) Responsibility for Providing Care and Supervision, is being cited on the attached LIC 809D.

LPA Kendal Zirbes informed facility representative Annabell Lopez Magana that this report dated 08/04/2023 document(s) one Type A citation(s) which shall be posted for 30 consecutive days as there is an immediate risk(s) to the health, safety, or personal rights of children in care.

Also, LPA Kendal Zirbes informed the facility representative to provide a copy of this licensing report dated August 4, 2023, that documents any Type A citation(s) to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.

A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100. An exit interview was conducted and the report was reviewed with the facility representative Annabell Lopez Magana.

SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Kendal Zirbes
LICENSING EVALUATOR SIGNATURE:	DATE: 08/04/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/04/2023

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 08/04/2023 03:03 PM - It Cannot Be Edited

Created By: Kendal Zirbes On 08/04/2023 at 02:07 PM

Link to Parent Document Below:

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME: SAN BERNARDINO CHILD DEVELOPMENT CENTER	FACILITY NUMBER: 364808413
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 08/04/2023

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 08/04/2023 Section Cited CCR 101429(a)(1)	1 2 3 4 5 6 7	101429 Responsibility for Providing Care and Supervision for Infants (a) In addition to Section 101229… (1) Each infant shall be constantly supervised and under direct visual observation and supervision by a staff person at all times. This requirement was not met as evidenced by:	1 2 3 4 5 6 7	On June 28, 2023, staff were provided with Supervision training. Staff are completing a daily inspection of the play yard before going outside to prevent future incidents from occurring. Documentation of the training was provided to the Department. No further action is required by the facility.
	8 9 10 11 12 13 14	Based on interviews, C1, C2, and C3 wandered outside of the enclosed play area without S1, S2 or S3 observing. This posed an immediate risk to the health and safety of children in care.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME:

Lady King

LICENSING EVALUATOR NAME:

Kendal Zirbes

LICENSING EVALUATOR SIGNATURE:

DATE: 08/04/2023

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/04/2023

LIC809 (FAS) - (06/04)

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